Validation of a Decision Instrument to Limit Pelvic Radiography in Blunt Trauma

Abstract

We sought to validate a set of criteria that predict, with a high degree of sensitivity, which patients may safely forgo pelvic radiography in their initial trauma evaluation. This is a prospective observational study. Adult blunt trauma patients presenting from July 1, 2002 to June 30, 2003 who underwent pelvic radiography were eligible for the study. Physicians completed data sheets that outlined five criteria (altered level of consciousness, complaint of pelvic pain, pelvic tenderness on examination, distracting injury, clinical intoxication) before viewing pelvic radiographs. Final radiographic results were later added. Fractures were classified as clinically significant or insignificant based on the Tile classification. There were 973 patients enrolled in the study; 62 patients had pelvic fractures (prevalence 6.4%). The decision instrument predicted fracture in 60 patients, (sensitivity 96.8%, 95% CI 92.4-100%). Two fractures were clinically insignificant. If only clinically significant fractures were considered, the instrument had a sensitivity of 100%. The decision instrument predicted, with a high degree of sensitivity, those patients who could safely forgo pelvic radiography after blunt trauma. Approximately 44% of our patient population could have done without a pelvic X-ray, resulting in significant saving of health care dollars. These criteria need to be prospectively validated.

Screening US for Blunt Abdominal Trauma: Objective Predictors of False-Negative Findings and Missed Injuries

“…Similarly, although urinalysis and chest radiography were performed in all patients, radiographs of the lumbar spine and pelvis were obtained on a case-bycase basis at the discretion of the trauma service, because our institution's trauma assessment procedure includes selective radiographic screening of the lumbar spine and pelvis on the basis of clinical suspicion (18). Thus, an imaging reference standard for lumbar and pelvic fractures was not available in all study subjects, and it is conceivable that some patients in the low-risk group may have had undiagnosed fractures.…”